Keanu Reeves and Lily Collins in 'To the Bone,' which premieres July 14 on Netflix.

Help with eating disorders

• The National Association of Eating Disorders runs a helpline — 800-931-2237 —that is available from 6 a.m. to 6 p.m. Mondays through Thursdays and 5 a.m. to 3 p.m. Fridays. The organization also has a 24-hour crisis text line: People can text “NEDA” to 741741 to be connected with a trained volunteer. Details: nationaleatingdisorders.org

• Project Heal, a national nonprofit, offers stories of hope and inspiration at theprojectheal.org

In the new Netflix film, "To the Bone," up-and-coming young star Lily Collins plays Ellen, a 20-year-old woman with anorexia who is starving herself to death because she has come to believe that she can never been thin enough.

The film won't be released for streaming until July 14, but it's already creating quite a stir. Some groups say this major motion picture could offer an opportunity to start an important national discussion about eating disorders, what the national nonprofit Project Heal calls "the most stigmatized, misunderstood and under-recognized of all mental illnesses."

But others worry that "To the Bone" could be the next "Thirteen Reasons Why." That is, another Netflix movie accused of romanticizing self-destructive and potentially lethal thinking and behavior among teens and young people.

"To the Bone," which also stars Keanu Reeves as Collins' caring but unconventional doctor, isn't out yet, so it's difficult for many to assess how truthfully and responsibly — or not — the movie deals with a serious and complicated topic.

An estimated 20 million women and 10 million men suffer from anorexia nervosa, bulimia nervosa, binge eating or some other eating disorder at some point in their life, according to the National Association of Eating Disorders. Moreover, anorexia nervosa has the highest mortality rate of any psychiatric disorder.

On its own, the "To the Bone" trailer, released last month, intensified discussion on social media over whether the film will provide dangerous behavioral "triggers" for people deep in the disease or struggling to recover. Some found the trailer to be worrisome:

The trailer opens with Collins, as Ellen, triumphantly counting up the calories of different dishes on her dinner plate. Later, viewers get a quick glance at what's presented as Ellen's backbone on her emaciated frame, visible through an opening in her hospital gown.

Calorie-counting scenes, and images of Ellens's emaciation (which the film's creators say were created with CGI visual effects), have popped up on pro-anorexia websites and blogs, according to some reports. Fans of these sites regard Collins, who lost weight for the role, and the trailer as "thinspiration."

For these fans, the trailer and the movie supposedly offer ways to learn new tips and techniques to perpetrate their illness. Experts on eating disorders say that people devoted to the "thinspo" aesthetic have distorted thinking on what constitutes a healthy body image.

"Caregivers might get very nervous about their loved ones seeing this film," says Monica Waldman, a member of the board of the Los Gatos-based Eating Disorders Resource Center who also has a college-aged daughter recovering from anorexia.

Waldman explained that family members like her worry that such images could give loved ones the flawed notion that they are fine the way they are or encourage those in recovery to relapse. "Even if it shows someone so emaciated she looks like a concentration camp victim, the person with the eating disorder looks at that and thinks 'That looks good, that's what I want to look like.' "

Waldman noted, however, that she's only seen the trailer. So, she's not ready to write the film off. Far from it.

She wants to see the film, and is considering whether she'll suggest to her daughter that they watch it together. "Let's see what the movie actually entails," she said.

Moreover, she agrees with experts who think the film has the potential to do a lot of good as a work of popular entertainment. "A number of caregivers believe the world needs to be educated," Waldman said, pointing out: "And a movie is a form of education."

In its statement, Project Heal says "To the Bone" sheds light "on the severity and complexity of eating disorders — capturing the impact of these perplexing illnesses on both patient and family — while emphasizing that recovery is possible." Project Heal was founded in 2008 by two teenage girls who met while undergoing treatment for anorexia and helped each other reach full recovery.

Meanwhile, Collins and Marti Noxon, the film's writer and director, have defended the film in a very specific way — by opening up about their own struggles to recover from anorexia.

Noxon, who reportedly incorporated her own experiences with recovery into the narrative, took to Twitter to say that the goal of the film is definitely not to glamorize eating disorders. Instead it is to "serve as a conversation starter about an issue that is too often clouded by secrecy and misconceptions."

In an interview with Vanity Fair in January, Collins said she was initially reluctant to accept the role, especially as she had overcome her own illness about 10 years earlier. She said: "Why would I want to put myself back in that situation?"

But after reading the script, Collins said she was just "in awe" and not because the film would be about anorexia. "It is so much more," she said. "And I felt like my journey and my experiences could benefit (an audience). And I knew that with Marti involved, this could help me face a fear again."

Collins, the daughter of music legend Phil Collins, said she was especially interested in helping people in the film and fashion industries talk more openly about eating disorders as both put a premium on women being stick thin.

"It is just such a taboo topic that I think people avoid because people feel uncomfortable talking about it," Collins said. "But the second that they do, anyone who knows someone or is going through it themselves feels less alone."

Collins, her co-star Keanu Reeves and other castmates also took a break from filming to record a public service announcement called "Nine Truths About Eating Disorders."

Kristina Saffran, the co-founder and executive director of Project Heal, believes Noxon and Collins have their hearts in the right place. However, her organization acknowledges that the film could be "triggering" for some people. For this reason, Project Heal recommends people with eating disorders carefully evaluate where they are in recovery before viewing this film.

Saffran said in a statement that many things were triggering for her early in recovery, but now she's at a place in life where being around those triggers "solidifies how strong I am in recovery and how I never want to go back."

You are solely responsible for your comments and by using TribLive.com you agree to our
Terms of Service.

We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.

While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.

We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers

We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.

We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.

We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.

We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent
via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.